An End to Individual Therapy?

Time Magazine is reporting that Yale psychologist Alan Kazdin has called for the end of individual therapy.

While he does not quite go that far, he does suggest, in Time’s words that individual therapy is “overrated and outdated.”

If you take a closer look at the Kazdin’s research paper, you will see that he sees individual therapy as an inefficient way to deliver mental health services to those who need them.

In truth, he sees a vast quantity of untreated mental illness, and wants to help find ways for the profession to tap this new marketing opportunity.

Among other things Kazdin recommends telephone sessions, Skype sessions, diet and nutrition, and self-help books.

Strangely enough, Kazdin does not mention the therapeutic value of aerobic exercise or of yoga. He also ignores the most effective and efficient delivery system for mental health treatment—Alcoholics Anonymous and its offshoots.

While Kazdin does write that “one–to-one therapy will always have a place” he largely prefers what he calls “evidence-based therapies,” which means therapies that are based on cognitive principles.

In his words: “If you want to get over an anxiety disorder, do graduated exposure. But sit down and relate to me or love me like your mom and dad? There's no evidence for that.”

Here he is dismissing the importance of the human connection between patient and therapist. 

Yet, when he talks about how the therapist/patient relationship replicates something that happened with mother or father, he is referring to what psychoanalysis has called transference.

Not to be too technical about it, but therapy conducted in terms of transference specifically precludes anything like a human connection between patient and therapist. If the attachment must always repeat something that happened in the past, no real connection is possible in the present.

Kazdin does not grant sufficient importance to the fact that most patients come to therapy because they are suffering some form of social anomie, dislocation or dissociation, feelings of loneliness or rejection.

For anyone who is feeling detached and adrift connecting with another human being confers therapeutic benefits beyond those that are gained by doing cognitively-prescribed homework exercises.

I agree that a good relationship will not cure an anxiety disorder, but there is a great deal more to most therapeutic practices than anxiety disorders.

Kazdin seems to recognize this. He defines psychotherapy as follows: “Psychotherapy is defined broadly in this article to include systematic efforts to apply psychosocial intervention to reduce distress or maladaptive behavior or enhance adaptive functioning. Psychosocial intervention, in contrast to medical or biological intervention (e.g., medication, surgery), focuses on such means of change as interpersonal interaction and systematic experiences (e.g., new ways of behaving through practice, role-playing, homework assignments, advice) designed to produce change.”

To me this resembles coaching and some forms of cognitive therapy more than insight-oriented therapy. In fact, it leaves no place for the kinds of insights that have long been a staple of individual therapy.

Still, if a therapist is going to function as a coach he had best tailor his approach to the person he is working with. Otherwise, his pearls of wisdom will fall on deaf ears.

If patients do not develop a relationship of trust with their therapists they will not willingly accept advice and counsel. Therapists delude themselves if they think that making their practice more like science will inspire their patients to grant their words the credence that they would give to scientifically-proven hypotheses.

In his Time interview Kazdin makes another remark that I find especially intriguing: “When I was starting out, I thought that the public would be an ally, but research shows that satisfaction with therapy is not very much related to getting better. [So, they don't necessarily realize they are not getting good treatment.]”

The bracketed sentence is published as such in the magazine. I do not know whether it should be attributed to Kazdin or is an editorial comment.

Assume that Kazdin is right, how does it happen that people can be perfectly happy with therapy that does not help them to get better.

Why have people continued to work in therapy when the treatments have not been producing good results? Perhaps, they have felt that there were no other viable treatment options. Or else, as I suspect, therapists have created a culture that has made it seem normal to have bad outcomes.

Therapy has often suggested that emotional outbursts are a sign of therapeutic progress. Sometimes it has implied that a depressed mood is a sign of a clear vision of reality. It has also suggested that making your life into a permanent psychodrama is a sign of therapeutic success.

In truth, if treatment and/or coaching is aimed at helping people learn how to negotiate differences and to achieve harmonious relationships, these outcomes, sanctioned by the therapy culture are really signs of failure.